Treatment of high grade cervical intraepithelial neoplasia by photodynamic therapy using hexylaminolevulinate may be costeffective compared to conisation procedures due to decreased pregnancy-related morbidity

Soergel, Philipp; Makowski, Lars; Makowski, E; Schippert, Cordula; Hertel, Hermann; Hillemanns, Peter

doi:10.1002/lsm.21072

Cited by 10 publications

(12 citation statements)

References 32 publications

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“…7,8,10 Although tissue sparing treatments like electrosurgical loop conizations (LEEP) are widely used today, the rising neonatal morbidity and mortality have significant implications due to the large number of necessary conizations. 7,8,10,12,30 In the last years, the recently approved two HPV 16/18 vaccines have raised hope among healthcare professionals throughout the world. The vaccines are highly effective when vaccinating young girls prior to sexual intercourse.…”

Section: Discussionmentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

“…The algorithm for the calculation of neonatal morbidity, mortality and associated costs has been reported earlier and described here: 12 In a recently published study, we quantified the conizationassociated neonatal morbidity and mortality for Germany. 12 The estimated number of conizations in women between 15-43 y was 52,610 for Germany 2009. 30 Among 665,142 births in 2009, there were 5,931 pregnancies with a history of a conization procedure (data from the German federal perinatal database and the Lower Saxony perinatal database).…”

Section: 3mentioning

confidence: 99%

“…7,8 As the main burden of high grade CIN is allocated in women of fertile age and conization procedures are common, the increased pregnancy risk is of high importance as it leads to significant perinatal morbidity and mortality. [7][8][9][10][11][12] Both HPV vaccines have been shown to be safe and highly effective in preventing CIN and cervical cancer from vaccine-HPV types. [2][3][4] Regarding the reduction of CIN and subsequent cervical surgery, it has to be considered that high-grade CIN caused by other types than the vaccine-types 16 and 18 may be reduced by crossover protection for some HPV types.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20][21][22][23][24][25] However, in none of these analyses the possible reduction of neonatal mortality and morbidity due to conization-related prematurity has been taken into account, although this may represent a significant position. 12 This study aims at evaluating the cost-effectiveness of an HPV 16/18 vaccine in preventing neonatal mortality and morbidity by reducing the number of precedent maternal conization procedures.…”

Section: Introductionmentioning

confidence: 99%

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The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity

Soergel

Makowski

Schippert

et al. 2012

Human Vaccines & Immunotherapeutics

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Introduction: Cervical intraepithelial neoplasia (CIN) represents the precursor of invasive cervical cancer and is associated with human papillomavirus infection (HPV) against which two vaccines have been approved in the last years. Standard treatments of high-grade CIN are conization procedures, which are associated with an increased risk of subsequent pregnancy complications like premature delivery and possible subsequent life-long disability. HPV vaccination has therefore the potential to decrease neonatal morbidity and mortality. This has not been taken into account in published cost-effectiveness models. Material and Methods: We calculated the possible reduction rate of conizations for different vaccination strategies for Germany. Using this rate, we computed the reduction of conization-associated preterm deliveries, life-long disability and neonatal death due to prematurity. The number of life-years saved (LYS) and gain in quality-adjusted life-years (QALYs) was estimated. The incremental costs per LYS / additional QALY were calculated. Results: The reduction of conization procedures was highest in scenario I (vaccination coverage 90% prior to HPV exposition) with about 50%. The costs per LYS or additional QALY were lowest in scenario I, II and III with 45,101 J or 43,505-47,855 J and rose up to 60,544 J or 58,401-64,240 J in scenario V (50% vaccinated prior to sexual activity + additional 20% catch-up at a mean age of 20 y). Conclusion: Regarding the HPV 16/18 vaccines as "vaccines against conization-related neonatal morbidity and mortality" alone, they already have the potential to be cost-effective. This effect adds up to reduction of cervical cancer cases and decreased costs of screening for CIN. Further studies on cost-effectiveness of HPV vaccination should take the significant amount of neonatal morbidity and mortality into account.

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Section: Discussionmentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity

Soergel

Makowski

Schippert

et al. 2012

Human Vaccines & Immunotherapeutics

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5-Aminolevulinic acid-based fluorescence diagnostics of cervical preinvasive changes

Vansevičiūtė¹,

Venius²,

Letautienė³

2014

Medicina

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The purpose of this article is to review the diagnostic possibilities of 5-aminolevulinic acid (5-ALA)-based fluorescence diagnosis of preinvasive cervical changes. Reviewed papers were selected from the PubMed database with keywords combining the terms individual cervical neoplasia and fluorescence diagnostics. The regular colposcopy procedure lacks specificity; therefore, new methods are continually sought for superior diagnosis of cervical pathology. 5-ALA-based fluorescence diagnostics is under investigation as an up-to-date diagnostic technique for cervical intraepithelial neoplasia (CIN). This method is grounded on the topical or systemic application of 5-ALA, which induces excess production of the endogenous photosensitizer protoporphyrin IX (PpIX) in tissues where carcinogenesis has begun. The conversion of PpIX to the heme is less efficient in tumors; therefore, higher amounts of PpIX tend to accumulate in premalignant and malignant tissues. Illumination with light of the appropriate wavelength initiates excitation of PpIX fluorescence, which in turn helps to localize PpIX-rich areas and identify potentially malignant tissues. A number of investigations suggest that because of its high selectivity for tumors and low toxicity to healthy tissues, 5-ALA-based diagnosis seems a promising tool for the noninvasive identification of cervical intraepithelial neoplasia.

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The effect of light fractionation with a 2-h dark interval on the efficacy of topical hexyl-aminolevulinate photodynamic therapy in normal mouse skin

Middelburg

Bruijn

Heuvel

et al. 2013

Photodiagnosis and Photodynamic Therapy

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Treatment of high grade cervical intraepithelial neoplasia by photodynamic therapy using hexylaminolevulinate may be costeffective compared to conisation procedures due to decreased pregnancy-related morbidity

Cited by 10 publications

References 32 publications

The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity

The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity

5-Aminolevulinic acid-based fluorescence diagnostics of cervical preinvasive changes

The effect of light fractionation with a 2-h dark interval on the efficacy of topical hexyl-aminolevulinate photodynamic therapy in normal mouse skin

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